J Korean Soc Matern Child Health.  2019 Jul;23(3):155-161. 10.21896/jksmch.2019.23.3.155.

Smoking Exposure and Placental Vascular Compromise: A Nationwide Population-Based Study in South Korea

Affiliations
  • 1Research Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 2Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea. jiupark@naver.com
  • 3Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
This study aims to investigate the effects of smoking on the development of placenta-associated syndromes, including preeclampsia, abruptio placentae, and placenta previa, which share the common pathophysiology of vascular compromise of the placenta.
METHODS
A total of 966,629 pregnancies identified from the Korean National Insurance Claims Database and the National Health Information Database were analyzed from 2010 to 2014. The adjusted odds ratio and attributable risk of smoking for the development of placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, were analyzed. Maternal age, alcohol consumption, exercise habit, and economic status were controlled as confounding variables. A binary logistic regression model was used, and simple and multiple logistic regression analyses were performed.
RESULTS
Among 966,629 pregnancies, 11.86% of women were ever smokers. Ever smokers had a higher risk of developing placenta previa (adjusted odds ratio, 1.23; 95% confidence interval [CI], 1.18-1.29; adjusted attributable risk, 18.70%). The adjusted odds ratio of developing placenta-associated syndromes in ever smokers compared to nonsmokers over the age of 35 years with a low economic status was 1.32 (95% CI, 1.18-1.47), with an adjusted attributable risk of 23.95%.
CONCLUSION
The risk of developing placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, is high in ever smokers. Pregnant ever smokers who are >35 years and belong to the lower one-third of the economic division require special care to prevent the development of placenta-associated syndromes.

Keyword

Smoking exposure; Placenta-associated syndrome; Placenta vascular compromise

MeSH Terms

Abruptio Placentae
Alcohol Drinking
Confounding Factors (Epidemiology)
Female
Humans
Insurance
Korea*
Logistic Models
Maternal Age
Odds Ratio
Placenta
Placenta Previa
Pre-Eclampsia
Pregnancy
Smoke*
Smoking*
Smoke

Reference

Aliyu MH., Lynch O., Wilson RE., Alio AP., Kristensen S., Marty PJ, et al. Association between tobacco use in pregnancy and placenta-associated syndromes: a population-based study. Arch Gynecol Obstet. 2011. 283:729–34.
Article
Ananth CV., Savitz DA., Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol. 1996. 144:881–9.
Article
Ananth CV., Vintzileos AM. Epidemiology of preterm birth and its clinical subtypes. J Matern Fetal Neonatal Med. 2006. 19:773–82.
Article
Cain MA., Salemi JL., Tanner JP., Kirby RS., Salihu HM., Louis JM. Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes. Am J Obstet Gynecol. 2016. 215:484.e1–484.e14.
Article
Chang HH., Larson J., Blencowe H., Spong CY., Howson CP., Cairns-Smith S, et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet. 2013. 381:223–34.
Article
Choi S., Kim Y., Park S., Lee J., Oh K. Trends in cigarette smoking among adolescents and adults in South Korea. Epidemiol Health. 2014. 36:e2014023.
DeLorenze GN., Kharrazi M., Kaufman FL., Eskenazi B., Bernert JT. Exposure to environmental tobacco smoke in pregnant women: the association between self-report and serum cotinine. Environ Res. 2002. 90:21–32.
Article
Dukic VM., Niessner M., Benowitz N., Hans S., Wakschlag L. Modeling the relationship of cotinine and self-reported measures of maternal smoking during pregnancy: a deterministic approach. Nicotine Tob Res. 2007. 9:453–65.
Article
Jauniaux E., Burton GJ. Morphological and biological effects of maternal exposure to tobacco smoke on the fetoplacental unit. Early Hum Dev. 2007. 83:699–706.
Article
Khong TY., De Wolf F., Robertson WB., Brosens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol. 1986. 93:1049–59.
Article
Kim TH., Lee HH., Chung SH., Kim SS., Hong YP. Risk factors of preterm delivery and survival rate of preterm infants in Bucheon. Korean J Obstet Gynecol. 2010. 53:29–34.
Article
Kim YJ., Lee BE., Park HS., Kang JG., Kim JO., Ha EH. Risk factors for preterm birth in Korea: a multicenter prospective study. Gynecol Obstet Invest. 2005. 60:206–12.
Kyrklund-Blomberg NB., Gennser G., Cnattingius S. Placental abruption and perinatal death. Paediatr Perinat Epidemiol. 2001. 15:290–7.
Article
Kyrklund-Blomberg NB., Granath F., Cnattingius S. Maternal smoking and causes of very preterm birth. Acta Obstet Gynecol Scand. 2005. 84:572–7.
Article
Lee BE., Hong YC., Park HS., Lee JT., Kim JY., Kim YJ, et al. Maternal exposure to environmental tobacco smoke (ETS) and pregnancy outcome (low birth weight or preterm baby) in prospective cohort study. Korean J Prev Med. 2003. 36:117–24.
Lindbohm ML., Sallmén M., Taskinen H. Effects of exposure to environmental tobacco smoke on reproductive health. Scand J Work Environ Health. 2002. 28 Suppl 2:84–96.
Ngo AD., Chen JS., Figtree G., Morris JM., Roberts CL. Preterm birth and future risk of maternal cardiovascular disease - is the association independent of smoking during pregnancy? BMC Pregnancy Childbirth. 2015. 15:144.
Article
Qiu J., He X., Cui H., Zhang C., Zhang H., Dang Y, et al. Passive smoking and preterm birth in urban China. Am J Epidemiol. 2014. 180:94–102.
Article
Ray JG., Vermeulen MJ., Schull MJ., Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005. 366:1797–803.
Article
Sasaki S., Braimoh TS., Yila TA., Yoshioka E., Kishi R. Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy--a validation study in Northern Japan. Sci Total Environ. 2011. 412-13:114–8.
Stone WL., Bailey B., Khraisha N. The pathophysiology of smoking during pregnancy: a systems biology approach. Front Biosci (Elite Ed). 2014. 6:318–28.
Article
Talhout R., Schulz T., Florek E., van Benthem J., Wester P., Opperhuizen A. Hazardous compounds in tobacco smoke. Int J Environ Res Public Health. 2011. 8:613–28.
Article
Thielen A., Klus H., Müller L. Tobacco smoke: unraveling a controversial subject. Exp Toxicol Pathol. 2008. 60:141–56.
Article
Tikkanen M., Nuutila M., Hiilesmaa V., Paavonen J., Ylikorkala O. Prepregnancy risk factors for placental abruption. Acta Obstet Gynecol Scand. 2006. 85:40–4.
Article
Zhang J., Fried DB. Relationship of maternal smoking during pregnancy to placenta previa. Am J Prev Med. 1992. 8:278–82.
Article
Zhang J., Savitz DA. Maternal age and placenta previa: a population-based, case-control study. Am J Obstet Gynecol. 1993. 168:641–5.
Article
Full Text Links
  • JKSMCH
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr